熊去氧胆酸治疗妊娠期肝内胆汁淤积症的临床效果及对患者妊娠结局影响

Effect of ursodeoxycholic acid on intrahepatic cholestasis of pregnancy and pregancy outcome

目的观察熊去氧胆酸治疗妊娠期肝内胆汁淤积症的效果及对患者妊娠结局的影响。方法选取2016年6-12月武汉市普仁医院妇产科收治的108例妊娠期肝内胆汁淤积症患者作为研究对象。按照随机数字表法分为对照组和观察组，各54例。对照组常规给予地塞米松磷酸钠注射液肌内注射连续治疗14d，观察组在对照组基础上给予熊去氧胆酸胶囊口服连续治疗14d，比较2组患者的临床疗效、血清生化指标、瘙痒症状评分和妊娠结局指标。结果观察组治疗总有效率明显高于对照组[96．3％（52／54）比81．5％（44／54）]，差异有统计学意义（P〈0．05）。治疗后观察组血清生化指标（丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、总胆汁酸、直接胆红素）和瘙痒症状评分均明显低于对照组[（30．1±2．2）U／L比（45．4±2．8）U／L、（27．5±2．2）U／L比（41．2±2．5）U／L、（18．2±2．0）μmol／L比（27．2±2．1）μmol／L、（1．77±0．23）μmo]／L比（2．17±0．68）μmol／L、（9．8±1．1）μmol／L比（4．6±0．9）μmol／L、（1．08±0．15）分比（2．18±0．24）分]，观察组妊娠结局指标（妊娠期高血压、前置胎盘、剖宫产、胎儿窘迫、早产、胎膜早破、羊水过多、产后出血、泌尿感染、新生儿不良症）发生率均明显低于对照组，差异均有统计学意义（均P〈0．05）。结论熊去氧胆酸治疗妊娠期肝内胆汁淤积症临床效果肯定，在缓解患者瘙痒症状、改善肝功能和改善妊娠结局等方面具有明显的作用。

Objective To observe the effect of ursodeoxycholic acid on intrahepatic cholestasis of pregnancy and pregency outcome. Methods Totally 108 patients with intrahepatic cholestasis of pregnancy admitted from June to December 2016 in Department of Obstetrics and Gynecology of Wuhan Puren Hospital were randomly divided into control group and observation group, with 54 cases in each group. The control group was treated with dexamethasone sodium phosphate intranluseular injection for 14 d; the observation group took ursodeoxycholic acid capsules for 14 d on the basis of control group. Clinical curative effect, serum biochemical indicators, score of pruritus and pregnancy outcome were analyzed. Results The total effective rate in observation group was significantly higher than that in control group E 96. 3% （ 52/54 ） vs 81.5% （44/54） ] （ P 〈 o. 05 ）. Levels of serum biochemical indicators（ alanine aminotransferase, aspartate aminotransferase, total bilirubin, total bile acid and direct bilirubin） and score of pruritus after treatment in observation group were significantly lower than those in control group E （30. l ± 2.2） U/L vs （45.4±2.8） U/L, （27.5±2.2） U/L vs （ 41.2 ± 2.5 ） U/L, （ 18.2 ± 2.0 ）μmol/L vs （27.2 ± 2. 1 ） μmol/L, （ 1.77 ± 0.23 ） Ixmol/L vs （ 2. 17±0.68 ） μmol/L, （ 9.8 ±1.1 ） μmol/L v s （ 4.6 ±0.9 ）μmol/L, （ 1.08±0. 15 ） points vs （2. 18 ± 0.24） points ] （ P 〈 0.05 ）. Incidences of pregnancy outcome events （ gestational hyper- tension, placenta previa, cesarean section, fetal distress, premature delivel~~, premature rupture of fetal membranes, hydramnios, postpartum hemorrhage, urinary infection and deficiencies in newborn） in observation group were signif- icantly lower than those in control group（ P 〈 0. 05 ）. Conclusion Ursodeoxycholic acid treating intraimpatie chole- stasis of pregnancy can relieve pruritus symptoms, improve liver function and improve pregnancy outcome.